Individual
SIRAJABID KHATIB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
441 N WABASH AVE, MARION, IN 46952-2612
(765) 662-4236
(765) 662-4903
Mailing address
330 N WABASH, SUITE G20, MARION, IN 46952-2600
(765) 660-7600
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01050026A
IN
208M00000X
Hospitalist Physician
01050026A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001150856
ANTHEM
IN
05
—
200375870
—
IN
Enumeration date
08/15/2005
Last updated
12/26/2019
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